■报告表明,在世界贸易中心(WTC)遭受恐怖袭击后,在救援行动中服务的个人的大脑健康状况比预期的要差。
■在一项对WTC反应者的前瞻性研究中,评估65岁之前痴呆的发生率,并比较严重暴露于碎片的反应者与未暴露于建筑物碎片或佩戴个性化防护设备(PPE)的反应者之间的发生率。
■这项前瞻性队列研究于2014年11月1日至2023年1月1日进行,这是一项学术医学监测计划,可用于居住在长岛的经过验证的WTC响应者。纽约在第一次认知评估时,年龄在60岁或更小而没有痴呆的反应者每18个月进行一次随访。平均而言,长达5年。
■暴露严重程度基于对WTC暴露和暴露相关活动的详细问卷的答复,其中包括暴露于细颗粒粉尘和潜在的神经毒性碎片。工作时间,以及PPE的使用。暴露水平分为从低到严重的5类。
■65岁之前的全因痴呆发病率是主要结果。遵循标准指南,依靠重复的认知测量来诊断痴呆症。
■在9891名响应者中,5010人符合纳入这项认知功能研究的资格(中位[IQR]年龄,53[48-57]岁;4573[91.3%]男性)。在15913.1人年的随访中,发现了228例痴呆症病例。WTC暴露严重程度的增加与每1000人年痴呆发病率的增加有关(低,2.95[95%CI,1.07-11.18];轻度,12.16[95%CI,10.09-14.79];中等,16.53[95%CI,13.30-20.81];高,30.09[95%CI,21.35-43.79];严重,42.37[95%CI,24.86-78.24])。适应社会,人口统计学,和相关的医疗因素,暴露严重程度的每个单位增加与痴呆发病率增加相关(调整后的风险比,1.42[95%CI,1.18-1.71];P<.001;平均风险差异,每1000人年9.74[95%CI,2.94-32.32];P<.001)。
■在这项针对WTC反应者的队列研究中,他们在这些独特的暴露中幸存下来,并参与了2014年至2022年的认知纵向随访研究,与暴露水平最低的反应者或使用PPE的反应者相比,在65岁之前,更严重的灰尘或碎片暴露与更高的痴呆风险显著相关.这项研究表明,可靠地使用PPE可能有助于预防65岁之前暴露于不受控制的建筑物倒塌的个体的痴呆症发作。未来的研究有必要确定与暴露相关的痴呆个体的大脑生物标志物。
UNASSIGNED: Reports suggest that the individuals who served in rescue operations following the terrorist attacks on the World Trade Center (WTC) have poorer brain health than expected.
UNASSIGNED: To assess the incidence of dementia before age 65 years in a prospective study of WTC responders and to compare incidence among responders with severe exposures to debris vs responders not exposed to building debris or who wore personalized protective equipment (PPE).
UNASSIGNED: This prospective cohort study was conducted from November 1, 2014, to January 1, 2023, in an academic medical monitoring program available to verified WTC responders residing on Long Island, New York. Responders 60 years of age or younger without dementia at the time of their first cognitive assessment were followed up every 18 months, on average, for up to 5 years.
UNASSIGNED: Exposure severity was based on responses to a detailed questionnaire of WTC exposures and exposure-related activities that included exposures to fine particulate dust and potentially neurotoxic debris, duration of work, and the use of PPE. Exposure level was divided into 5 categories ranging from low to severe.
UNASSIGNED: Incidence of all-cause dementia before age 65 years was the primary outcome. Dementia was diagnosed following standard guidelines relying on repeated measures of cognition.
UNASSIGNED: Of 9891 responders, 5010 were eligible for inclusion in this study of cognitive function (median [IQR] age, 53 [48-57] years; 4573 [91.3%] male). There were 228 cases of dementia identified during 15 913.1 person-years of follow-up. Increasing WTC exposure severity was associated with incremental increases in the incidence rate of dementia per 1000 person-years (low, 2.95 [95% CI, 1.07-11.18]; mild, 12.16 [95% CI, 10.09-14.79]; moderate, 16.53 [95% CI, 13.30-20.81]; high, 30.09 [95% CI, 21.35-43.79]; and severe, 42.37 [95% CI, 24.86-78.24]). Adjusting for social, demographic, and relevant medical factors, each unit increase in exposure severity was associated with increased incidence of dementia (adjusted hazard ratio, 1.42 [95% CI, 1.18-1.71]; P < .001; mean risk difference, 9.74 [95% CI, 2.94-32.32] per 1000 person-years; P < .001).
UNASSIGNED: In this cohort study of WTC responders who survived these unique exposures and participated in a longitudinal follow-up study of cognition from 2014 through 2022, when compared with responders with the lowest exposure levels or responders who used PPE, more severe exposure to dust or debris was significantly associated with a higher risk of dementia before 65 years of age. This study suggests that the reliable use of PPE might help prevent the onset of dementia before age 65 years among individuals exposed to an uncontrolled building collapse. Future research is warranted to determine cerebral biomarkers for individuals with exposure-associated dementia.